HX64077608 
RA982.B65  M386     The  early  history  of 


1ENTS  of  the  writer. 


THE  EARLY  HISTORY 


McLEAN  ASYLUM  FOR  THE  INSANE. 


A    CRITICISM   OF   THE  REPORT  OF   THE  MASSACHUSETTS  STATE 
BOARD    OF  HEALTH  FOR  1877. 


MORRILL   WTMAN,  M.  D. 


[Reprinted  from  The  Boston  Medical  and  Surgical  Journal,  December  13,  1877.] 


CAMBRIDGE  : 

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First  Physician  and  Superintendent  of  the 

McLean  Asylum  for  the  Insane. 

at  Woburn,  Mass.,  1778;  D.  at  Roxbury,  Mass.,  iE 


THE   EARLY   HISTORY 

OF    THE 

MCLEAN  ASYLUM  FOR  THE  INSAKE. 

A    CRITICISM    OF   THE     REPORT     OF     THE    STATE   BOARD    OF    HEALTH   FOR 

1877. 

BY    MORRILL  WTMAN,    M.    D. 

The  Report  of  the  State  Board  of  Health  of  Massachusetts  for  the 
present  year  contains  an  article,  by  Dr.  Charles  F.  Folsom,  secretary 
of  the  board,  entitled  Disease  of  the  Mind.  Its  principal  object,  in  the 
words  of  the  general  report  of  the  board,  is  to  show,  "  by  citing  well- 
known  historical  facts,  that  during  the  past  century  very  great  strides 
have  been  made  in  the  treatment  of  mental  disease." 

After  quoting  from  the  reports  of  Dr.  Bell  and  of  Dr.  Earle,  made 
in  1847  and  1848,  with  regard  to  the  very  few  instances  of  personal  re- 
straint of  the  insane  under  their  care,  Dr.  Folsom  makes  the  following 
statement.     The  paragraph  is  quoted  entire. 

"  With  all  this,  the  excited  insane  were  found  by  a  committee  of  our 
legislature  in  1848  to  be  at  the  Worcester  Asylum  even  in  small  rooms, 
'  having  the  least  advantages  for  light,  none  for  ventilation,  unfavorably 
located,  dark,  dreary,  damp,  and  uncomfortable  to  that  extent  as  to 
aggravate  rather  than  to  assist  the  cure  of  the  unfortunate  beings 
placed  there ; '  the  male  violent  insane  at  the  McLean  Asylum,  then 
considered  one  of  the  best,  were  kept  in  stone  cells  in  the  cellar  ;  and 
this  simply  indicates  the  general  knowledge  of  the  time.  The  position 
and  condition  of  the  more  quiet  of  the  insane  in  asylums  were  very  much 
better  of  course  ;  but  it  was  reserved  for  further  study  and  experience 
to  show  that  the  most  violent  may  be  treated  to  a  certain  extent  in  a 
similar  way."  1 

Many  persons,  medical  men  and  others,  have  received  from  this  state- 
ment very  erroneous  impressions  as  to  the  apartments  and  treatment  of 
the  violent  male  insane  at  the  McLean  Asylum.  If  these  impressions 
were  well  founded  it  would  be  a  stain  upon  the  reputation  of  those  who 
instituted  and  continued  such  measures,  and  upon  the  board  of  trustees, 
for  whose  fidelity  and  judicious  care  of  the  asylum  from  its  foundation 
it  would  be  hard  to  find  a  parallel. 

1  Board  of  Health  Eeport  for  1877,  page  353. 


2  The  Early  History  of  the  McLean  Asylum. 

I  have  therefore  thought  it  best  to  correct  the  errors  of  statement  in 
the  above  extract  by  a  carefully  prepared  description,  with  drawings,  of 
the  building  occupied  by  the  violent  male  insane,  and  also  to  show  what 
was  the  state  of  knowledge  with  regard  to  insanity  and  its  treatment 
generally  at  the  McLean  previous  to  the  period  referred  to. 

I  am  impelled  to  do  this  not  only  because  the  statement  is  a  part  of 
the  report  of  the  State  Board  of  Health,  and  has  been  distributed  as 
such,  but  also  because  it  has  been  distributed  in  a  separate  pamphlet, 
with  an  authority  which  would  not  have  attached  to  an  individual  writer. 

It  may  be  here  remarked  that  I  have  more  than  a  general  inter- 
est in  correcting  these  errors.  My  father,  Dr.  Rufus  Wyman,  was 
appointed  in  1818  the  first  physician  and  superintendent  of  the  asylum  ; 
in  1835,  after  seventeen  years  of  service,  his  health  failing  under  the 
care  and  anxiety  inseparable  from  such  an  institution,  he  resigned.  My 
early  life  and  a  part  of  my  medical  pupilage  were  spent  there.  I  may 
therefore  be  presumed  to  know  something  of  its  history. 

When  my  father  entered  upon  his  duties  he  found  buildings  already 
erected.  They  consisted  of  a  large  and  elegant  house,  the  mansion  of 
a  gentleman  of  wealth,  to  which  the  trustees  of  the  hospital  had  added 
two  wings,  each  seventy-six  feet  in  length  by  forty  in  breadth.  The  em- 
inence upon  which  these  buildings  stand  is  remarkable  for  its  beauty, 
and  although,  in  the  words  of  the  trustees,  "  the  situation  selected  ap- 
pears to  unite  every  practical  advantage,"  it  is  much  too  small  to  admit 
of  the  proper  arrangement  of  the  buildings  on  the  same  level.  The 
wings,  as  originally  built,  not  differing  materially  in  plan  from  hotels, 
are  on  a  level  several  feet  lower  than  the  mansion.  The  buildings  since 
added  are  necessarily  on  a  still  lower  level.  This  abrupt  slope,  although 
it  has  some  advantage  and  gives  excellent  opportunity  for  drainage, 
has  compelled  a  crowding  together  of  the  different  structures  not  desir- 
able, and  no  little  skill  and  ingenuity  have  been  required  to  obviate  to 
the  present  extent  this  objection. 

"  The  male  violent  insane  were  kept  in  stone  cells  in  the  cellar." 
How  far  this  statement  correctly  represents  the  facts  it  is  now  proposed 
to  examine. 

The  apartments  occupied  by  the  violent  male  insane  in  1848,  the 
rooms  to  which  the  report  refers,  are  known  at  the  asylum  as  the 
"  strong  rooms,"  and  are  four  in  number.  They  are  in  a  brick  build- 
ing, fifty-four  feet  by  twenty-three  feet,  called  the  "  lodge  "  or  "  re- 
treat; "  it  stands  at  the  east  of  the  mansion  and  quite  detached  from  it. 
It  was  planned  by  my  father  and  built  under  his  direction  in  1826.  I 
have  his  original  memoranda  and  manuscript  plans,  with  a  report  to  the 
trustees  in  March,  1825,  on  additions  to  be  made  to  the  asylum,  of 
which  this  building  was  one. 

When  the  "  lodge  "  was  built,  the  McLean  Asylum,  which  was  the 


The  Early  History  of  the  McLean  Asylum.  3 

first  in  New  England,  had  been  open  eight  years;  during  this  period  it 
had  received  a  larger  proportion  than  ever  since  of  patients  from  jails 
and  almshouses,  where  they  had  no  proper  care.  Some,  neglected  by 
those  who  had  charge  of  them,  were  filthy  and  noisy  ;  treated  for  years 
like  lower  animals,  they  came  to  resemble  them  in  many  of  their  habits  ; 
they  had  no  proper  rooms,  and  suffering  from  cold  in  winter  were  often 
confined  in  cellars ;  their  keepers,  glad  to  be  rid  of  them,  sent  them  to 
the  newly  opened  asylum.  Subsequently,  the  earlier  removal  of  the 
insane  to  asylums  probably  much  diminished  the  number  who  fell  into 
this  dreadful  condition. 

The  "  lodge  "  was  originally  of  two  stories,  the  upper  intended  for 
idiots  and  epileptics,  those  who  were  objectionable  in  their  habits  or 
subject  to  sudden  outbreaks  of  frenzy.  In  this  story  the  rooms  were 
arranged  as  to  warming,  ventilation,  and  lighting  as  in  the  story  below ; 
the  floor  was  to  be  warmed  by  steam  or  hot  air  circulating  in  channels 
beneath  it.  These  apartments,  however,  were  never  finished,  the  num- 
ber of  patients  requiring  them  having  lessened.  They  were  afterwards 
remodeled  ancTfitted  for  a  different  class  of  persons.  The  rest  of  the 
"  lodge  "  is  in  the  main  as  originally  built,  with  the  exception  of  an 
upper  story  added  by  Dr.  Bell  in  1850. 

The  lower  story  contains  the  "  strong  rooms."  These  are  now  as 
when  first  built,  except  the  front  walls,  which  were  removed  last  year 
when  the  building  was  transferred  to  the  steward's  department.  The 
class  of  boarders  formerly  occupying  them  is  now  in  the  "  Bowditch 
ward  "  for  excited  cases. 

It  should  be  distinctly  understood  that  these  rooms  were  exclusively 
for  those  unfortunate  persons,  some  of  whom  are  to  be  found  in  most  large 
asylums,  who  at  times  are  violent  and  noisy,  who  destroy  their  clothing, 
their  bedding,  even  to  the  very  mattresses  on  which  they  sleep,  who 
defile  their  rooms  in  every  possible  way,  —  the  most  violent  male  insane. 
No  others  were  ever  placed  in  these  rooms.  Their  number  is  small ; 
these  four  rooms  were  more  than  sufficient  for  one  hundred  and  fifty  male 
boarders  at  the  McLean.  Mr.  Tyler,  for  more  than  thirty  years  con- 
nected with  the  asylum  as  attendant,  supervisor,  and  steward,  a  highly 
valued  officer,  assures  me  that  more  than  two  rooms  were  never  known 
to  have  been  occupied  at  the  same  time.  But  small  as  the  number  is, 
even  if  it  be  but  a  single  individual,  he  should  be  provided  for  in  the 
manner  best  suited  to  his  individual  case.  How  this  is  to  be  done  has 
been  a  difficult  problem,  and  it  is  likely  always  will  be.  Reasoning  and 
persuasion  can  avail  nothing.  They  may  be  drugged  with  narcotics, 
but  experience  has  decided  against  this  plan  for  any  length  of  time. 
Some  would  have  them  kept  in  apartments  similar  to  those  of  the  more 
quiet,  and  in  their  vicinity,  holding  and  restraining  them  by  sufficient 
manual  force  ;  others  think  they  should  be  secured  and  prevented  from. 


1  The  Early  History  of  the  McLean  Aaylum. 

doing  mischief  to  themselves  or  others  by  means  of  manacles,  strait- 
waistcoats,  camisoles,  muffs  or  mittens,  as  producing  less  desire  for  re- 
sistance than  when  opposed  by  manual  strength.  But  neither  of  these 
plans  prevents  noise  and  filth,  which  render  them  utterly  unfit  compan- 
ions for  the  more  quiet.  Others,  again,  prefer  to  abolish  all  restraint  upon 
the  limbs,  and  while  the  paroxysm  lasts  leave  these  most  unfortunate 
sufferers  in  proper  apartments,  where  they  can  be  made  safe,  and  as  far  as 
possible  comfortable,  allowed  the  full  exercise  of  their  limbs,  and  where 
neither  their  noise  nor  their  habits  will  disturb  any  one.  This  last 
is  the  method  adopted  by  my  father  at  the  McLean.  It  was  to  carry 
out  this  method  that  he  urged  upon  the  trustees  in  1825  the  immediate 
erection  of  the  "  lodge."  Its  use  was  continued  during  the  adminis- 
tration of  Dr.  Bell,  who  succeeded  him  at  the  asylum  in  1836. 

In  consequence  of  the  formation  of  the  ground,  as  above  described,  one 
side  and  one  end  of  the  lower  story  of  the  "  lodge,"  for  about  one  half 
its  height,  stands  against  a  retaining  wall.  The  other  side  (the  front) 
and  the  other  end  opened  upon  an  airing  court  fifty-seven  by  fifty;  the 
floor  of  the  "  lodge  "  generally  is  two  feet  above  the  surface  of  the  ground, 
the  western  end  somewhat  less,  the  ground  falling  off  from  the  building 
in  both  these  directions.  On  this  floor,  at  this  height  above  the  surface 
of  the  ground,  and  in  the  front  of  the  building,  are  the  "  strong  rooms." 
Below  the  floors  of  these  rooms  is  the  cellar,  about  seven  feet  deep,  ex- 
tending under  the  whole  building.  This  cellar  is  well  lighted  with 
windows  on  the  front  and  end,  paved  with  bricks,  well  ventilated,  and 
every  part  clean  and  whitened.  Here  is  the  furnace  for  heating  the  air 
for  warming  and  ventilating  the  "  strong  rooms  "  above,  and  also  the 
especial  arrangement  for  warming  their  floors.  These  "  strong  rooms  " 
nowhere  come  in  contact  with  the  external  walls  ;  they  are  completely 
surrounded  by  corridors  about  five  feet  wide,  properly  ventilated  and 
warmed,  summer  and  winter.  They  are  lighted  by  windows  in  the  front 
wall,  and  also  by  smaller  windows  on  the  opposite  side.  The  "  strong 
rooms  "  are  eleven  feet  by  seven  and  a  half  on  the  floor,  ten  feet  in 
height,  the  ceiling  an  elliptic  arch,  with  a  ventilating  flue  in  the  centre. 
They  are  entered  by  doors  from  the  corridors,  and  lighted  through  un- 
glazed  windows  about  two  feet  square,  never  closed  in  any  way.  Directly 
opposite  these  windows  are  the  large  windows,  about  three  by  five  feet, 
in  the  front  of  the  building,  opening  upon  the  airing  court.  In  the  cor- 
ridor are  doors  by  which  each  room  is  completely  separated  from  the 
others,  and  sound  cut  off  as  much  as  possible.  Each  room  can  be 
reached  without  passing  any  other.  The  walls,  like  those  of  other  rooms 
in  the  asylum,  are  of  brick  plastered  with  Portland  cement,  made  as 
smooth  as  possible  ;  the  corners  are  rounded  for  cleanliness,  as  has  re- 
cently been  done  for  the  new  wards  of  the  Massachusetts  General  Hos- 
pital.    In  one  corner  is  a  close-stool  communicating  with  the  corridor 


The  Early  History  of  the  McLean  Asylum.  5 

through  the  side  of  the  room ;  in  two  of  the  corners,  are  seats  properly 
fastened  to  the  wall.  The  floor  is  of  granite  slabs,  eight  or  ten  inches 
thick,  smoothly  hammered,  and  laid  in  cement.  This  floor  is  inclined 
towards  one  corner  of  the  room,  that  next  the  corridor,  where  there  is 
a  proper  outlet  and  waste-pipe.  This  secures  the  immediate  draining 
away  of  water  during  the  washing  of  the  floor,  of  necessity  frequently 
repeated  with  this  class  of  patients. 

Notwithstanding  the  ample  preparations  for  ventilation  and  wanning 
the  air  of  the  rooms  and  corridors,  it  was  deemed  essential  that  the  floor 
also  should  be  well  warmed.  To  do  this  effectually  and  equably  is  a 
matter  of  no  little  difficulty.  To  be  comfortable  to  those  without  cloth- 
ing it  should  have  a  temperature  of  about  100°  ;  this  degree  of  warmth 
cannot  be  obtained  from  air  fitted  for  respiration.  In  these  "  strong 
rooms"  the  difficulty  is  met  by  warming  the  stone  floor  by  a  fire  be- 
neath. It  had  already  been  successfully  tried  in  a  room  in  the  asylum 
(it  was  not  of  stone  nor  in  a  cellar)  fitted  up  for  patients  of  this  class. 
The  fuel  was  burned  in  a  proper  fire-place,  and  the  heated  gases,  after 
circulating  through  the  whole  space  beneath  the  floor  of  the  rooms,  es- 
caped by  a  chimney.  The  floors  were  thus  warmed  night  and  day, 
summer  and  winter,  the  thick  slabs  of  granite  keeping  up  an  equable 
temperature  hardly  to  be  obtained  in  any  other  way.  This  method  of 
warming  is  by  no  means  new ;  it  is  essentially  that  of  the  ancient  hyp- 
ocaust,  used  two  thousand  years  ago  at  Pompeii,  as  is  fully  shown  by 
the  excavations  and  also  by  the  drawings  upon  the  walls  of  the  baths 
in  this  favorite  watering-place  of  the  Romans.  In  Pompeii  the  walls 
and  ceilings  also  were  hollow  and  warmed  by  the  same  fire. 

Adjoining  the  main  corridor  is  the  bath-room,  and  near  that  the  room 
for  clothing. 

The  interior  of  the  rooms  is  as  plain  as  possible,  but  in  other  parts 
there  is  as  much  of  architectural  ornamentation  as  the  use  of  the  build- 
ing will  allow. 

The  room  for  the  attendants  is  at  the  head  of  the  stairs  directly  over 
the  "  strong  rooms,"  where  they  can  be  within  hearing  of  their  charge 
and  reach  them  at  once  either  night  or  day. 

The  drawings  give  in  plan  and  section  the  details  of  the  "  lodge." 

It  appears  from  this  description,  which  I  have  endeavored  to  make 
accurate,  that  the  "  lodge  "  had  an  airing  court  fifty-seven  by  fifty  for 
the  use  of  the  patients.  That  the  strong  rooms  are  quite  open  and  above 
ground  on  two  sides ;  on  the  other  sides  they  are  partially  belcw  the 
surface  ;  on  all  sides  they  are  surrounded  by  corridors  well  lighted,  well 
warmed,  and  ventilated.  They  are  themselves  fully  lighted  and  warmed 
by  two  methods,  each  independent  of  the  other;  they  are  nowhere 
within  five  feet  of  the  external  wall,  and  have  below  them  a  cellar 
seven  feet  deep,  also  well  warmed,  lighted,  and  ventilated.     A  room 


6  The  Early  History  of  the  McLean  Asylum. 

so  situated,  having  but  one  of  its  six  sides  of  stone,  can  hardly  be  de- 
scribed with  scientific  exactness  as  a  "  stone  cell  in  a  cellar."  Few- 
persons  would  suspect  from  the  report  of  the  board  the  true  position 
and  construction  of  these  rooms,  the  amount  of  skill,  thought,  and  ex- 
perience which  have  been  bestowed  upon  them,  nor  the  degree  of  safe 
custody  and  comfort,  without  restraint  upon  the  limbs,  that  they  have 
brought  to  those  who  occupied  them.  I  am  quite  sure  that  on  no  other 
part  of  the  asylum  did  the  physician  exercise  more  fully  his  great  talent 
for  contriving  and  executing  accommodations  for  the  insane  than  here. 
This  his  numerous  plans,  sketches,  and  memoranda  clearly  show.  I 
am  equally  sure  that  no  patients  received  more  care,  or  were  more  con- 
stantly in  his  thoughts,  than  the  unfortunate  persons  for  whom  it  was 
designed.  It  cannot  be  said  of  these  rooms,  as  is  said  in  the  report 
of  1848  of  those  in  the  Worcester  Asylum,  that  they  are  "  rooms  having 
the  least  advantages  of  light,  none  for  ventilation,  unfavorably  located, 
dark,  dreary,  damp,  and  uncomfortable." 

It  may  be  interesting  to  know  that  when  the  report  of  the  commit- 
tee of  our  legislature  in  1848,  just  referred  to,  was  made,  new  strong 
rooms  for  females  were  being  erected  at  Worcester  from  money  appro- 
priated by  the  State,  and  in  1850,  these  having  been  found  good  and 
well  suited  to  their  purpose,  similar  rooms  were  built  for  males  ;  they 
were  substantially  imitations  of  the  strong  rooms  of  the  McLean. 

The  idea  that  these  rooms  are  in  the  cellar  may  have  arisen  from 
the  fact  that  they  may  be  reached  in  two  ways  :  either  by  entering  the 
left  wing  at  the  second  story  from  the  level  of  the  ground  of  the  centre 
house  or  mansion,  and  descending  by  the  stairs  to  the  level  of  the  cellar 
of  the  wing  ;  or  they  may  be  entered  directly  from  the  airing  courts, 
above  which  they  are  raised  by  the  usual  underpinning  of  two  feet,  as 
is  clearly  shown  by  the  elevation  and  section.  The  lower  story  of  the 
new  Bowditch  ward,  for  excited  patients,  may  be  reached  by  an  under- 
ground passage  descending  from  the  floor  of  the  "  lodge  "  by  seventeen 
steps,  but  it  is  also  entered  directly  from  its  airing  court,  the  floor  of 
the  two  buildings  being  about  equally  raised  above  their  respective 
courts.  The  new  Worcester  Asylum,  now  nearly  finished,  owing  to  a 
similar  formation  of  the  ground,  has  a  retaining  wall  of  about  half  the 
height  of  that  at  the  McLean,  against  which  the  rooms  for  the  excited 
patients  are  placed.  By  no  proper  use  of  language  can  either  be  said 
to  be  in  a  cellar. 

The  size  of  the  "  strong  rooms  "  as  compared  with  rooms  for  excited 
patients  in  some  other  asylums  deserves  notice.  At  the  Danvers  State 
Asylum,  now  just  finished,  the  rooms  for  excited  patients,  according  to 
the  official  report,  are  seventy-two  in  number,  each  twelve  feet  long, 
eight  feet  wide,  and  eleven  and  one  half  feet  high  ;  at  the  McLean 
they  are  eleven  feet  long,  seven  and  one  half  feet  wide,  and  ten  feet 


The  Early  History  of  the  McLean  Asylum.  7 

high  ;  at  the  new  Worcester  State  Asylum,  nearly  finished,  they  are  ten 
feet  long,  eight  and  one  half  feet  wide,  and  eight  feet  and  eight  inches 
high  ;  the  cubic  space  for  each  patient  at  the  Danvers  is  the  greatest, 
the  McLean  next,  and  the  Worcester  least. 

The  materials  of  which  the  walls  of  the  several  rooms  in  these  three 
asylums  are  constructed  are  substantially  the  same  :  in  all  they  are  of 
brick  ;  at  Danvers  and  the  McLean,  plastered  with  Portland  cement  in 
the  neatest  and  smoothest  manner  ;  at  Worcester,  of  bricks  painted, 
without  plaster.  The  McLean  is  the  only  one  with  rounded  corners. 
The  floors  at  Danvers  and  Worcester  are  of  wood,  not  warmed ;  those 
at  the  McLean  are  of  stone,  warmed. 

The  McLean  "  strong  room  "  was  provided  with  a  comfortable  mat- 
tress, or,  if  this  were  destroyed,  with  the  best  materials  as  a  substitute 
that  could  be  found.  It  had  seats  and  a  close-stool.  By  a  strict  rule 
of  the  asylum  these  rooms  were  the  first  visited  in  the  morning.  Every 
morning  before  breakfast  the  patient  was  bathed  and  placed  in  a  similar 
adjoining  room.  Everything  which  had  become  soiled  was  removed, 
the  room  well  washed,  and  the  walls  and  floor  carefully  cleaned  with 
transparent  lime-water,  which  left  the  walls  free  from  odor  and  visible 
lime  deposit.  The  warm  stone  floor,  besides  the  comfort  it  gives,  must, 
in  a  sanitary  point  of  view,  be  considered  the  best.  It  does  not  absorb 
offensive  matter  of  any  kind,  —  a  very  important  fact  if  faecal  matter 
is  the  source  of  so  much  "  germ  disease,"  as  sanitarians  now  assert ; 
it  is  quickly  dried,  and  again  fit  for  use.  If  really  better  than  wood 
it  should  not  be  rejected  because  of  its  apparent  harshness,  and  it 
would  not  be  if  we  consider  for  a  moment  the  condition  of  the  pa- 
tients. They  have  been  accommodated  elsewhere  as  long  as  possible. 
They  are  violent  and  raving  in  their  excitement  or  delirium,  pay  little 
attention  to  their  surroundings,  and  are  so  wanting  in  regard  to  the 
common  decencies  of  life  that,  for  the  quiet  and  comfort  of  others  as 
well  as  of  themselves,  their  temporary  seclusion  has  become  a  neces- 
sity. As  to  the  floor  itself,  it  is  practically  no  harder  than  a  hard  pine 
floor  ;  neither  yields  to  the  pressure  of  the  body. 

Dr.  Bell,  in  his  report  for  1839,  after  more  than  ten  years'  experience, 
says  of  these  patients :  "  There  are,  it  is  true,  certain  cases  where  the 
mind  is  so  frenzied  and  chaotic  that  the  individual  is  reckless  and  uncon- 
scious of  what  he  does  ;  here  the  provision  of  a  suitable  lodge  room  with 
stone  floor,  warmed  by  steam  or  hot  air  below,  without  glass  or  mov- 
able furniture,  is  the  best  and  kindest  appliance  which  can  be  adopted 
for  a  few  days  until  medical  and  soothing  treatment  can  place  the  suf- 
ferer in  a  condition  to  be  operated  upon  by  moral  means.  We  never 
have  had  occasion,  since  the  institution  has  been  under  my  care,  to  use 
strong  rooms  as  places  of  permanent  detention,  a  few  weeks  being  the 
extent  of  time  which  they  have  ever  been  occupied  by  a  single  person." 


8 


The  Early  History  of  the  McLean  Asylum. 


The  following  letter  from  the  eminent  alienist,  Dr.  Isaac  Ray,  gives 
his  opinion  of  the  "  strong  rooms,"  and  their  fitness  for  those  who  occu- 
pied them  :  — 

My  dear  Sir,  —  I  recollect  perfectly  the  rooms  of  the  violent  and 
excited  patients  at  the  McLean  Asylum,  to  which  you  refer.  They 
were  in  the  basement  story,  and  constructed  very  much  like  other 
patients'  rooms.  They  opened  upon  a  common  corridor,  some  four  or 
five  feet  wide,  which  was  lighted  by  ordinary  windows  in  the  wall. 
This  light  passed  into  the  rooms  through  an  unglazed  window  by  the 
side  of  the  door.  The  floors  were  made  of  stone  slabs,  which  were 
heated  by  a  fire  beneath,  and  thus  the  air  was  warmed  by  heat  radiated 
from  the  floors.  I  always  thought  them  very  well  fitted  for  their  allotted 
purpose,  that  of  keeping  violent,  raving  patients,  and  I  never  saw  them 
occupied  by  any  others.  They  were  justly  regarded,  I  think,  consid- 
erably in  advance  of  any  other  existing  means  for  keeping  that  descrip- 
tion of  patients.  Of  course  improvements  have  followed  the  increase 
of  means.  The  rooms  now  used  for  that  purpose  look  out  by  a  glazed 
window  into  a  yard,  the  walls  are  smoothly  plastered,  the  use  of  steam 
has  led  to  a  better  method  of  warming,  and  the  doors  open  upon  a 
long,  broad  hall,  tastefully  wainscoted  and  painted.  All  these  were 
very  desirable,  as  anything  is  which  gives  a  more  cheerful  aspect  to  the 
patient's  surroundings.  But  they  add  little  or  nothing  to  the  essential 
requisites  of  a  strong-room,  —  freedom  of  movement,  perfect  cleanliness, 
good  warmth,  and  ventilation,  —  and  in  these  particulars  the  old  lodge 
rooms  have  never  been  surpassed,  to  my  knowledge. 

Dr.  Folsom  speaks  of  the  strong  rooms  at  Worcester  and  at  the 
McLean  in  the  same  breath,  and  in  such  a  manner  that  an  incautious 
reader  might  suppose  there  was  little  to  choose  between  them.  It 
would  not  be  worth  while  now  to  describe  the  former.  It  is  enough 
to  say  that  they  were  destitute  of  the  prime  requisites  just  mentioned, 
while  their  surroundings  were  of  the  most  repulsive  character. 

You  are  at  liberty  to  make  any  use  of  this  letter  which  will  serve 
your  purpose.  Yours  truly,  I.  Ray. 

Dr.  Wtman. 
3509  Baring  Street,  Philadelphia,  September,  1877. 

Having  corrected  the  errors  of  statement  as  to  the  rooms  for  the  vio- 
lent insane,  I  will  now  consider  the  state  of  knowledge  with  regard  to 
insanity  generally  and  its  treatment  at  the  McLean. 

The  report  of  the  board  assures  us  that  the  state  of  things  which  it 
assumes  to  have  existed  at  the  McLean  in  1848  "simply  indicated  the 
general  knowledge  of  the  time,"  —  a  somewhat  sweeping  conclusion 
and  not  very  precise  in  its  meaning.  It  is  reasonable  to  conclude,  how- 
ever, that  whatever  else  was  intended  by  the  expression  it  means  that 
the  state  of  knowledge  at  that  time  was  at  a  low  ebb.     It  is  possible, 


The  Early  History  of  the  McLean  Asylum.  9 

too,  that  the  generalization  was  first  made  in  the  interest  of  progress, 
and  in  seeking  for  facts  in  support  of  this  statement  the  selection  of  the 
McLean  is  not  quite  happy.  However  this  may  be,  as  the  McLean 
has  been  selected  it  is  now  proposed  to  show  from  memoranda  and  the 
report  of  its  physician  in  18*25  the  knowledge  with  regard  to  the  treat- 
ment of  the  insane  then  existing.  There  is  no  reason  to  believe  that 
this  knowledge  was  less  in  1848. 

The  report  to  the  trustees  from  which  the  following  extracts  are  made 
•is  dated  March,  1825: — 

"  In  constructing  buildings  for  lunatics,  their  comfort,  happiness,  and 
cure  should  be  regarded  as  the  ultimate  and  all-important  objects. 
Other  objects  contributing  to  the  accomplishment  of  these  great  ends 
are  of  almost  equal  importance.  Among  these  are  provisions  for  the 
attendants  conveniently  to  manage  the  patients  and  to  execute  the 
orders  and  directions  of  those  to  whom  is  confided  the  general  superin- 
tendence of  the  institution.  Upon  the  care,  fidelity,  and  experience  of 
the  attendants,  the  quiet  conduct  and  the  eventual  recovery  of  the 
boarders  greatly  depend.  Suitable  attendants  cannot  be  procured  un- 
less their  convenience  in  the  discharge  of  their  duties  be  duly  regarded, 
or  if  procured  must  be  often  changed,  and  consequently  they  will  never 
acquire  the  requisite  experience." 

"  Few  persons  who  are  qualified  to  have  the  oversight  and  to  be  the 
companions  of  the  boarders  will  be  willing  to  perform  the  menial  services. 
Indeed,  these  services  degrade  the  attendant  in  the  opinion  of  those 
under  his  care,  and  render  them  less  submissive  and  respectful  in  their 
deportment.  He  should  therefore  have  an  assistant.  The  attendant 
would  be  likely  to  remain  in  the  asylum  a  long  time,  and  the  often 
changing  of  the  assistant,  if  necessary,  would  be  attended  with  little  in- 
convenience." 

At  this  time  the  attendants,  many  of  whom  had  been  school-teachers, 
were  selected  with  great  care,  usually  on  the  recommendation  of  their 
clergymen.  The  principal  attendants  were  required  to  keep  journals 
recording  the  condition  of  those  under  their  care  and  other  matters  per- 
taining to  the  administration  of  their  office.  This  was  done  not  only 
for  the  inspection  of  the  physicians,  but  also  to  secure  vigilance  and  close 
observation  on  the  part  of  the  attendants. 

"  The  feelings  and  opinions  of  relatives  and  friends  of  lunatics  must 
be  consulted,  for  they  are  to  select  the  residence  of  those  under  their 
care." 

"  The  public  also  must  be  consulted,  for  the  institution,  in  a  great  de- 
gree, depends  upon  the  charities  of  the  public  for  its  support,  especially 
for  the  funds  to  defray  the  expenses  of  erecting  its  buildings.  These 
contributions  are  to  be  expended  with  the  greatest  caution.  Every 
measure  and  every  plan  should  be  well  digested  before  any  attempt  to 
execute  it." 


10  The  Early  History  of  the  McLean  Asylum. 

"  The  first  great  object  presented  is  a  proper  classification  of  the 
subjects  of  a  lunatic  asylum.  The  evils  to  be  avoided  by  an  entire  sep- 
aration of  males  from  females  are  so  apparent  that  no  arguments  are 
needed  to  show  its  propriety.  A  further  division  of  lunatics  of  either 
sex  into  distinct  classes  or  families  is  not  to  be  disputed.  But  the  dif- 
ficulties attending  a  suitable  division  are  very  great.  These  difficulties 
are  various  according  to  the  form  of  government,  the  laws  and  customs 
of  the  country,  and  habits  of  the  lunatics.  In  all  cases  the  quiet  are  to 
be  separated  from  the  noisy  and  violent,  the  clean  from  the  dirty,  the 
clothed  from  the  naked,  and  the  latter  from  each  other,  that  one  patient 
should  in  the  least  possible  degree  disturb  or  offend  another.  Each 
division  should  form  a  little  family,  producing  the  greatest  degree  of 
comfort  and  happiness  of  which  its  members  are  susceptible.  Some 
individuals  who  are  much  disturbed  by  noise  require  the  most  perfect 
seclusion  and  solitude  ;  for  these  two  rooms  are  so  constructed  and  so 
situated  that  they  may  be  suitably  accommodated.  They  will  also  an- 
swer for  ordinary  sleeping  rooms." 

"  There  are  lunatic  males  who  are  generally  tranquil,  harmless,  sus- 
ceptible of  much  enjoyment,  capable  of  walking  abroad  without  an  at- 
tendant, and  in  fact  requiring  little  or  no  restraint.  Their  friends  find 
it  necessary  to  send  such  persons  from  home.  They  desire  for  them 
large,  handsome,  and  convenient  apartments,  and  sometimes  accommo- 
dations for  a  servant.  They  are  willing  to  pay  in  proportion  to  the 
accommodations  required.  Such  boarders  may  constitute  a  single  family, 
called  house  boarders,  and  have  apartments  in  the  connecting  wings  and 
front  part  of  the  centre  house." 

One  or  more  boarders  were  always  at  the  physician's  table,  had  rooms 
in  the  mansion  house,  and  mingled  with  his  family,  went  to  Boston  and 
elsewhere,  and  always  without  an  attendant.  The  more  quiet  also 
passed  their  evenings  in  the  physician's  family,  and  always  appeared 
and  were  treated  like  other  gentlemen.  Some  occupied  themselves  for 
months  together  as  teachers  of  the  physician's  children,  with  advantage 
to  both. 

"  Class  I.  Other  lunatics,  whose  friends  may  wish  for  them  hand- 
some rooms  and  galleries,  and  have  the  means  of  paying  the  necessary 
expenses,  still  require  to  be  restrained,  and  their  rooms  and  airing 
courts  must  be  so  constructed  that  they  cannot  easily  escape.  These 
may  constitute  the  first  class,  occupy  one  wing,  and  be  divided  into 
three  families,  each  living  in  a  single  story.  The  convalescents  and 
most  tranquil  may  take  the  upper  story,  the  most  noisy  and  turbulent 
may  take  the  basement  story,  and  the  remainder  may  take  the  middle 
story." 

"  Class  II.  A  second  class,  requiring  to  be  restrained,  may  occupy  the 
other  wing.     Neither  their  habits  of  life  nor  their  pecuniary  means  will 


The  Early  History  of  the  McLean  Asylum.  11 

require  or  permit  the  rooms  of  this  class  to  be  finished  or  furnished  in 
a  style  so  expensive  as  those  of  the  first  class.  They  may,  however, 
be  provided  with  every  comfort  and  convenience  to  be  found  in  the 
apartments  of  the  other  class,  and  have  everything  adapted  to  their 
habits  and  feelings.  This  class  will  also  be  divided  into  three  families, 
to  be  distributed  in  the  several  stories  as  is  contemplated  for  the  first 
class.  Provision  is  made  for  a  further  and  temporary  division  of  apart- 
ments whenever  any  particular  boarders  are  found  to  have  aversions  to 
each  other." 

"  The  wings  thus  improved  would  contain  accommodations  for  the 
quiet,  the  sick,  and  those  who  are  not  excessively  noisy." 

"  Class  III.  The  very  noisy,  dirty,  and  violent  patients  will  form  a 
third  class.  They  may  possibly  be  kept  in  the  wing  for  the  second 
class.  But  it  is  believed  a  distinct  building  is  to  be  preferred.  Apart- 
ments may  be  provided  in  the  same  building  for  idiots  and  epileptics. 
The  principal  objection  to  this  separation  is  that  the  worst  patients 
being  far  removed  would  be  likely  to  be  neglected.  But  the  comfort 
and  tranquillity  of  the  other  patients  require  the  removal,  and  the  neg- 
lect must  be  prevented  by  increased  vigilance." 

We  here  see  some  of  the  reasons  for  the  selection  of  the  site  for  the 
"  lodge  "  for  this  class.  It  is  as  closely  connected  with  the  wing  as 
possible,  and  yet  detached ;  the  four  rooms,  which  were  more  than  suffi- 
cient for  their  accommodation,  were  upon  that  side  farthest  removed 
from  the  other  buildings,  so  that  noise  and  shoutings  could  not  be  heard 
in  them  ;  this  allowed  the  free  opening  of  the  windows  of  the  lodge  at 
all  times. 

"  The  proper  situation  of  the  day  rooms  (or  parlors)  is  a  subject  on 
which  competent  judges  entertain  different  opinions.  In  several  well- 
approved  institutions  all  the  day  rooms  are  on  the  first  or  first  and  sec- 
ond stories.  Under  this  arrangement  those  who  occupy  the  upper  story 
are  during  the  day  removed  far  from  their  sleeping  rooms.  It  is  true 
they  have  a  more  easy  access  to  their  airing  courts,  and  the  attendants 
who  keep  in  the  day  rooms  can  more  readily  afford  assistance  to  each 
other  as  it  may  be  needed.  But  when  the  sleeping  rooms  join  the  gal- 
leries and  are  immediately  connected  with  the  day  rooms,  the  members 
of  the  family  occupying  the  same  are  under  less  restraint  and  have  a 
gx-eater  variety  of  accommodations.  If  sitting  in  the  day  room  become 
unpleasant,  the  gallery  is  at  hand  for  walking,  and  the  airing  court  is 
sufficiently  easy  of  access.  If  a  patient  be  feeble  or  wearied,  and  desir- 
ous of  passing  an  hour  upon  his  bed,  or  if  he  prefer  to  write  or  read 
without  the  presence  of  others,  his  room  is  near  and  within  the  hear- 
ing and  call  of  his  attendant.  These  reasons  seem  to  be  conclusive  for 
placing  the  sleeping  rooms,  day  rooms,  and  galleries  contiguous  to  each 
other  and  in  the  same  story." 


12  The  Early  History  of  the  McLean  Asylum. 

"  The  principal  objections  likely  to  be  urged  against  this  plan  are 
that  the  classes  will  be  too  numerous  for  quiet  or  safety,  and  will  re- 
quire the  day  rooms  (parlors)  to  be  too  large.  These  objections  do  not 
appear  to  me  to  be  valid  or  in  any  way  proportional  to  the  advantages 
gained." 

Great  differences  of  opinion  have  existed  among  those  in  charge  of 
the  insane  as  to  the  extent  to  which  classification  should  be  carried. 
The  plan  here  given  and  adopted  approached  individualization.  Dr. 
Bell  thought  it  was  carried  too  far.  Of  late  the  opinion  has  been  gain- 
ing ground,  especially  in  Europe,  that  a  "  strictly  individual  treatment  " 
is  needed.  This  cannot  be  approached  without  a  classification  at  least 
as  detailed  as  that  adopted  here  more  than  half  a  century  ago. 

"  The  centre  of  each  wing  may  be  carried  up  so  as  to  form  large 
halls  for  the  exercise  of  the  boarders  in  the  winter  and  in  stormy 
weather.  Work  rooms  may  be  here  constructed  in  which  the  exercise 
of  some  mechanic  arts  will  not  disturb  the  patients  in  the  lower  sto- 
ries." 

"  The  committees  and  the  board  of  trustees  may  hold  their  meetings 

•  1 

in  the  mansion  house,  some  part  of  which  may  be  used  for  the  chapel." 

The  physician  was  descended  of  a  Puritan  stock ;  he  believed  in  the 
stated  religious  observance  of  the  Sabbath;  he  had  written  in  its  defense, 
and  believed  what  he  wrote.  The  patients  who  were  able  attended  divine 
service  in  the  neighboring  churches.  .Religious  services  were  also  held 
m  the  wings  Sunday  evenings ;  during  which  the  physician  read  a  ser- 
mon to  those  who  were  well  enough  and  desired  to  attend. 

"  Each  family  is  also  provided  with  dining  and  work  rooms,  a  separate 
airing  court,  and  has  access  to  it  by  separate  stairs,  that  the  members 
of  different  families  may  not  mix  together.  The  courts  are  so  arranged 
that  patients  in  an  improved  state  of  mind  will  not  see  those  who  are 
in  a  worse  condition." 

"  Two  rooms  are  provided  for  those  who  need  inspection  during  the 
night." 

"  The  present  garden  for  the  exercise  of  the  male  boarders  would  be 
contiguous  to  their  airing  courts,  but  the  boarders  of  one  sex  could  not 
see  those  of  the  other  during  their  exercise  or  amusements.  The  hill 
to  be  formed  in  glacis  for  walks,  ornamented  with  trees  and  shrubbery." 

"  In  front  of  each  connecting  wing  is  a  small  court  and  a  low  building 
which  is  designed  for  house  boarders  who  may  be  sick  and  cannot  be  re- 
moved to  either  wing  or  retained  in  the  centre  house.  Small  buildings 
of  one  story  may  be  erected  in  the  rear  and  front  yards,  as  shown  in 
the  plans.  Their  height  will  not  obstruct  the  view  from  other  houses. 
This  is  a  want  which  ought  not  to  be  overlooked." 

We  have  here  a  plan  of  small,  detached,  one-story  hospital  buildings, 
much  after  that  now   so  strongly  advocated,  and  within   a  few  years 


The  Early  History  of  the  McLean  Asylum.  13 

adopted  by  the  other  branch  of  the  Massachusetts  General  Hospital  in 
Boston. 

"  Near  the  broad  steps  of  the  stairs  are  holes  through  which  the  gal- 
leries and  day  rooms  may  be  inspected  ;  similar  holes  are  in  the  walls 
of  the  dining-rooms  for  viewing  the  tables,  etc. ;  as  a  like  provision 
is  made  in  each  story,  the  whole  wing  may  be  inspected  without  the 
knowledge  of  the  boarders  or  attendants.  Through  these  apertures 
the  friends  of  a  patient  may  see  him  without  exposing  him  to  the  dan- 
gers of  a  visit." 

Unceasing  vigilance  is  the  safety  of  the  insane.  These  conveniences 
for  the  unexpected  inspection  of  the  boarders  by  their  friends  are  a 
part  of  a  plan.  When  the  boarders  were  in  the  airing  courts  they  were 
seen  by  their  friends  from  the  mansion  house  through  a  fine  telescope 
mounted  for  the  purpose.  Few  better  arrangements  could  be  devised 
for  giving  friends  confidence  in  the  treatment  pursued.  There  may  be 
objection  to  patients  seeing  their  friends,  but  none  to  the  friends  seeing 
the  patients.  The  influence  of  such  a  system  upon  all  connected  with 
the  institution  is  obvious. 

The  report  is  accompanied  by  detailed  plans,  in  accordance  with 
which  the  buildings  were  soon  after  erected. 

As  has  already  been  stated,  some  of  the  boarders  were  quite  at  liberty 
to  come  and  go  as  they  pleased.  These  found  their  own  occupation 
and  amusement ;  one  was  a  frequent  visitor  at  the  reading-room  of  the 
Boston  Athenaeum,  and  might  have  been  seen  daily  among  the  literary 
gentlemen  who  associated  there.  A  constant  effort  was  made  to  in- 
crease the  means  of  occupation  and  amusement  for  all.  Walking  in 
the  airing  courts  or  in  the  country  with  attendants,  going  to  church  on 
Sunday,  visiting  places  of  interest  on  other  days,  were  the  most  com- 
mon, or  riding  in  open  wagons  in  pleasant  weather.  Soon  afterwards 
the  physician  was  "  authorized  to  procure  a  carriage  and  pair  of  horses 
to  be  used  at  the  McLean  Asylum  for  the  insane,  for  the  purpose  of 
giving  air  and  exercise  to  the  boarders."1  These  rides  were  then,  as 
now,  taken  in  the  neighboring  country.  They  were  of  necessity  con- 
fined to  those  who  were  comparatively  quiet  and  well  behaved.  But 
there  were  others  who  needed  air  and  exercise  even  more  than  these  ; 
for  such  a  carriage-way  of  nearly  half  a  mile  in  circuit  was  made  round 
the  garden,  where  they  could  ride  and  where  neither  their  noise  nor 
their  appearance  would  disturb  any.  A  row-boat  upon  Charles  River, 
then  attractive  and  unpolluted,  was  in  frequent  use,  affording  an  amuse- 
ment particularly  relished  by  those  who  had  been  sailors,  of  whom  the 
asylum  usually  contained  several. 

In  summer,  excursions  in  the  harbor  in  large  boats  gave  a  pleasant 
sail,  a  run  upon  the  islands,  a  chowder  on  board,  and  all  the  enjoyment 
1  Bowditch's  History  of  the  Massachusetts  General  Hospital,  page  84. 


14  The  Early  History  of  the  McLean  Asylum. 

of  a  day  from  home.  There  was  bowling,  gardening,  the  exercise  of  the 
mechanic  arts,  books,  papers,  and  various  games.  Chess  was  a  favorite 
with  some  ;  the  physician  was  an  excellent  player,  and  not  unfrequently 
met  with  a  worthy  antagonist  among  his  boarders. 

Such  was  the  state  of  knowledge  and  such  the  condition  of  the  several 
classes  of  boarders  at  the  McLean  fifty  years  ago,  widely  different  from 
what  is  intended  to  be  conveyed  by  the  report  of  the  Board  of  Health. 

"  The  position  and  condition  of  the  more  quiet  of  the  insane  w^ere 
much  better  of  course,"  says  the  report  of  the  board,  "  but  it  was  re- 
served for  further  study  and  experience  to  show  that  the  most  violent 
may  be  treated  to  a  certain  extent  in  a  similar  way."  In  expressing 
this  opinion  it  is  to  be  regretted  that  we  have  no  account  of  this  improved 
treatment.  Indeed,  very  little  is  said,  either  directly  or  by  the  corre- 
spondents with  regard  to  the  "  most  violent."  We  read  much  —  and  very 
pleasant  reading  it  is  —  of  those  in  England  and  Scotland  whose  occupa- 
tions and  treatment  seem  to  be  much  like  that  just  described  as  existing 
here,  but  I  fail  to  find  a  satisfactory  description  of  the  other  class,  of 
their  treatment  and  apartments,  either  here  or  abroad.  The  study  and 
experience  of  a  Scotch  physician  as  late  as  1875  1  have  convinced  him 
that  seclusion  is  the  best  for  "  those  who  use  coarseness  of  language  " 
and  for  the  "  destructive  ;  "  of  these  last  two  or  three  cases  have  occurred 
in  his  asylum  in  a  year.  To  what  extent  seclusion  is  carried  we  have 
no  means  of  knowing,  nor  have  we  any  means  of  knowing  if  any  destroy 
their  clothing  and  bedding.  There  are  probably  such  cases  in  Europe ; 
we  certainly  have  them  in  Massachusetts.  The  report  gives  us  no  in- 
timation of  the  proportion  of  such  cases  nor  of  their  treatment,  either 
here  or  abroad  ;  instead  of  "  well-known  historic  facts  "  from  which  to 
judge  of  the  progress  in  treating  the  "  most  violent  "  like  the  more  quiet, 
we  have  an  opinion.  But  in  estimating  the  value  of  this  opinion  we 
must  remember  that  the  point  of  comparison,  the  "  stone  cells  in  the  cel- 
lar," is  proved  not  to  exist ;  indeed  the  whole  spirit  of  the  sentence,  so 
far  as  the  McLean  Asylum  is  concerned,  fails  to  show  a  just  apprecia- 
tion of  the  knowledge  and  practice  of  the  two  physicians  who  had  charge 
of  it  through  the  first  half  of  its  existence. 

A  more  ornamental  architecture  may  have  been  devised,  and,  it  may 
be,  some  minor  advantageous  changes  in  details,  in  the  hope  of  '•'  hiding 
by  their  comfortable  and  cheerful  arrangements  the  necessities  of  re- 
straint," but  other  than  these,  from  my  own  observation,  I  do  not  believe 
that  in  either  of  the  two  asylums  now  being  built  at  the  expense  of  the 
State  the  arrangements  for  lighting,  warming,  and  ventilating  the  apart- 
ments for  the  treatment  and  safe  custody  of  the  "  most  violent  "  insane 
are  material  improvements  over  those  in  use  at  the  McLean  fifty  years 
age.     The  Bowditch  excited  ward  is  for  another  class  of  patients,  as 

^Keport,  page  367. 


The  Early  History  of  the  McLean  Asylum.  15 

its  name  indicates  ;  it  has  no  room  peculiarly  fitted  for  the  comfort  of 
the  most  violent. 

It  must  not  be  supposed  that  I  deny  a  steady  amelioration  in  the 
treatment  of  the  insane  generally  during  the  past  fifty  years ;  that  would 
be  unjust  to  the  talented  and  devoted  laborers  in  this  field. 

Of  the  experiments  which  have  been  tried  here  with  a  reasonable 
hope  of  success,  some  have  led  to  important  changes  in  treatment ;  some 
have  been  repeated  abroad,  and  after  a  short  trial  accounts  of  them  reach 
us  as  novelties.  Dr.  Bell  in  his  final  report,  after  twenty  years'  service, 
has  some  instructive  remarks  on  this  subject. 

It  is  now  demonstrated : 

(1.)  That  the  report  has  not  fairly  represented  the  apartments  of 
the  violent  male  insane  at  the  McLean,  nor  their  treatment  during  the 
first  thirty  years  of  its  existence. 

(2.)  That  the  report  has  not  fairly  represented  the  state  of  knowl- 
edge at  the  McLean  with  regard  to  insanity,  nor  the  treatment  there  of 
the  insane  generally  during  the  same  period. 

The  report  has  been  written,  printed,  and  distributed  at  the  expense 
of  the  State  ;  it  bears  the  seal  of  the  Commonwealth  ;  it  goes  forth  to  the 
people  for  whom  it  is  written  as  a  historical  state  document,  and  takes 
its  place  in  public  libraries  bearing  an  authority  which  belongs  to  no 
individual  ;  its  statements,  therefore,  should  be  cautiously  made  and  care- 
fully verified.  It  is  to  be  hoped,  inasmuch  as  the  board  has  elsewhere 
been  pleased  to  make  favorable  mention  of  my  father's  services,  that 
the  facts  here  presented  under  a  sense  of  filial  duty  will  also  induce  it 
to  correct  any  errors  prejudicial  to  his  merits  into  which  it  may  have 
fallen.  As  the  first  physician  of  the  McLean  he  laid  well  and  deep 
the  foundation  of  a  class  of  public  charities  before  unknown  in  New 
England;  he  devoted  himself  to  the  one  great  object  of  his  life  with  an 
untiring  energy  and  fidelity  scarcely  to  be  equaled ;  the  evidence  of  the 
operations  of  his  mind  are  still  obvious  in  the  mechanical  and  architect- 
ural arrangements  and  in  the  moral  regime  and  internal  system  of  most 
of  the  institutions  for  the  insane  in  the  land.  Such  services  I  would 
not  have  forgotten  or  undervalued  in  a  history  of  insanity  by  an  official 
board  of  his  native  State. 

Cambridge,  December,  1877. 


Note  to  Page  13. 

The  following  extracts  indicate  the  principles  of  treatment  adopted  at  the 
McLean  by  its  first  physician. 

"A  knowledge  of  the  mental  functions  in  health  can  be  derived  only  from  the 
history  of  mental  operations.  This  history  of  facts,  with  the  laws  and  princi- 
ples deduced  therefrom  by  the  aid  of  a  sound  logic,  is  called  the  philosophy  of 
mind.  Mental  philosophy,  then,  is  an  indispensable  study  of  an  accomplished 
physician." 

"  The  treatment  of  insanity  chiefly  depends  upon  the  connexion  between  the 
mind  and  body.  If  there  be  inflammation  of  the  brain,  or  its  membranes,  it  is 
to  be  treated  as  inflammation  of  those  parts.  If  there  be  other  organic  disease, 
whether  of  structure  or  of  function,  in  any  part  of  the  body,  medical  treatment 
will  be  required.  But  in  mental  disorders,  without  symptoms  of  organic  disease, 
a  judicious  moral  management  is  more  successful.  It  should  afford  agreeable 
occupation.  It  should  engage  the  mind,  and  exercise  the  body;  as  swinging, 
riding,  walking,  sewing,  embroidery,  bowling,  gardening,  mechanic  arts;  to 
which  may  be  added  reading,  writing,  conversation,  &c,  the  whole  to  be  per- 
formed with  order  and  regularity.  Even  the  taking  of  food,  retiring  to  bed, 
rising  in  the  morning,  &c,  at  stated  times,  and  conforming  to  stated  rules  in 
almost  everything,  is  a  most  salutary  discipline.  It  requires,  however,  constant 
attention  and  vigilance,  with  the  greatest  kindness  in  the  attendants  upon  a 
lunatic.  Moral  treatment  is  indispensable,  even  in  cases  arising  from  organic 
disease. 

In  regard  to  medical  treatment,  I  believe,  that  purging,  bleeding,  low  diet,  &c, 
have  been  adopted  with  little  discrimination.  They  are  to  be  resorted  to  only 
when  there  is  organic  disease,  which  requires  the  'reducing  plan.''  But  these 
remedies,  especially  in  debilitated  subjects,  are  seldom  useful  in  relieving 
mental  disease.  They  are  usually  injurious,  and  frequently  fatal.  It  is 
undoubtedly  true,  that  impressions  upon  the  alimentary  canal  by  purging  or 
vomiting,  and  upon  the  skin  of  the  extremities  by  blistering,  are  useful  in 
chronic  cases  of  mental  disorders.  But  these  remedies  must  be  suited  to  the 
strength  and  general  health  of  the  patient." 

A  discourse  on  Mental  Philosophy,  as  connected  with  Mental  Disease, 
delivered  before  the  Massachusetts  Medical  Society,  June  2,  1830,  by  Rufus 
Wyman,  M.  D. 


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SECTION   OF   THE  LODGE. 


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^flyman 

The  early  M^ory  of  «.  *I~» 
&syl«m  for  the  insane. 

.  .      „  I.QrA-4        C-    U-    **! 


